Nine months into the U.S. launch of the first drug proven to slow the advance of Alzheimer's, Eisai and Biogen's Leqembi is facing an unexpected hurdle to widespread use: an entrenched belief among some doctors that treating the memory-robbing disease is futile.
These PET scan images provided by the New England Journal of Medicine in January 2024 show a reduction in amyloid-beta levels in an Alzheimer's patient. Nine months into the U.S. launch of the first drug proven to slow the advance of Alzheimer's, Eisai and Biogen's Leqembi is facing an unexpected hurdle to widespread use: an entrenched belief among some doctors that treating the memory-robbing disease is futile.
Another six scientists, all leaders in the field, said "therapeutic nihilism" – the belief that Alzheimer's is a hopelessly intractable disease – was playing a bigger role than anticipated in suppressing demand from primary care doctors, geriatricians and neurologists who could be sending patients to memory specialists for treatment.
"We are beginning to make more and more progress every single month. So we're still quite encouraged," Scott said. "This is a new journey, and I think it takes some time for providers to figure it out."Leqembi was the first amyloid-targeting drug granted full FDA approval after it slowed the decline in cognition in people in the early stages of Alzheimer's by 27% in a clinical trial.
Dr. Michael Greicius, a professor at Stanford University's Center for Memory Disorders, said there is little evidence that Leqembi benefits patients in a meaningful way. "There are significant risks associated with these drugs, there are significant costs, and I would say there is marginal benefit," said Dr. Eric Widera, a geriatrician and professor at University of California San Francisco, referring to amyloid-lowering treatments.
Geriatricians, geriatric social workers and nurses objected, arguing that the drug's statistically significant benefit was not clinically meaningful to patients, especially given the risks, he said. The companies said they intend to increase their sales force by 30% as they aim for 100,000 patients by 2026.
Castellano said the prospect of bleeding in the brain – a possible side effect of the drug - was her biggest concern, but her family believed the drug may offer a chance at slowing the disease. While Castellano can't tell if Leqembi is helping, she says the treatment has given her hope, and she doesn't mind the twice monthly infusions.
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